Rectoscopic devices



Aug. 28, 1962 F. A LBERTI RECTOSCOPIC DEVICES Filed Dec. 11, 1959Inventor:-

United States Patent Ofiflce 3&5 1,1 75 Patented Aug. 28, 1962 3,051,176REC'I'GSCOPIC DEVICES Franz Alberti, Lindenstrasse 52, Burgsteinfurt,Germany Filed Dec. 11, 1959, Ser. No. 859,070 3 Claims. (Cl. 128276)This invention concerns improvements in or relating to reotoscopicdevices. All previous devices for the withdrawal by suction of fluids orsecretions from the stomach, intestines, bladder or other cavities ofthe body are subject to the requirement that the device dips, wholly orpartially, into the medium to be drawn off and that the latter, asregards its position and extent, has first been determined exactly bysome other device. None of the hitherto known devices, however, makes itpossible to draw off the invisible fluid pockets in the bowel wall ofthe rectum, the position and extent of which are merely assumed andwhich are separated from the suction member by a layer of skin, and atthe same time, after the bowel wall has first been examined fordiscolouration and other deformities by means of the same apparatus, tomake the suction action visible by means of a built-in optical system. Adevice of this nature has not hitherto been required in medical science,since no corresponding diagnosis existed. The knowledge of the causes ofpsoriasis now makes such a device necessary.

Even now psoriasis is considered to be an incurable disease of unknowncauses in which one can only achieve a temporary improvement by variousmedical preparations mostly applied externally. Psoriasis is consideredby most specialists to be an allergic metabolic disease based onhereditary inclinations.

However, observations and experiments over many years resulted in thefollowing new knowledge:

(1) The scales which psoriasis produces on the surface of the skin, andthe fluid which the rectum excretes for self purification, areidentical.

(2) Psoriasis arises only when, owing to a local pathological change inthe mucosa, the rectum is incapable of excreting the fluid in a naturalway.

The larger the centres of disease of psoriasis are, the greater will bethe amount of fluid blocked in the bowel wall of the rectum.

In order to appreciate the technical problems which arise from thisknowledge, it is necessary to establish the the nature of the changes inthe anatomical structure of the rectum, which are caused by the disease.For this purpose there is shown in the accompanying drawing the diseasedportion of the bowel of the rectum, together with a device according tothe invention in section. As a result of constipation of the bowel orchronic sluggishness of the bowel, at first an inflammation of themucosa arises in the rectum, as a rule at a distance of 15-20 cm. fromthe anus. At a corresponding location this results in a local separationof the uppermost layer of the mucosa a (tunica mucosa) from the bowelwall. The mucosa b itself (lamina muscularis mucosa) lying beneath nowsecretes the fluid c into the resultant hollow space. During the initialstage, the fluid is passed to the interior of the bowel through thepores of the tunica. Gradually, however, the pores of the tunica becomeblocked up since they are no longer capable of following the oscillatorymovement of the bowel owing to their separation from the bowel wall,since, furthermore, the oscillatory movements of the rectum becomeincreasingly more sluggish owing to the swelling of the bowel, saturatedwith liquid, and since the bowel is cramped in the diseased area, in theattempt to express the fluid as a foreign body. As has already beenindicated, the next consequence is that the fluid, like any other fluid,is sucked up by the rectum, enters the blood stream, and is finallysecreted on the surface of the skin as scales of psoriasis. As a resultof the fluid continuously sucked up, the lowest layer of mucosa d(submucosa) and the bowel wall proper e, which consists of the circularand longitudinal muscle layers, are strongly swollen, so that the bowelgives the outward appearance of a colonal inflammation. The contrastpicture of a bowel diseased in this way only shows a constriction in thediseased area, the fluid secretions, however, remain invisible. Therectoscopic examination never yields any discovery. The reasons for thisare as follows: in the first instance, with a small separation area ofthe tunica mucosa, the fluid accumulating is promptly sucked up by thebowel, so that the separation of it remains invisible, and secondly theknown means do not make it possible to recognise the blocking up of thepores of the tunica. Only when the separation area of the tunica isextremely large and the suction capacity of the bowel does not sufliceimmediately to absorb the fluid accumulating, can the fluid secretionsbe recognised by congestion beneath the tunica, and by a slightdiscolouration of the uppermost layer of mucosa.

After having recognised these changes of the anatomical structure of therectum, caused by the disease, the technical problem to be solvedbecomes apparent.

According to the invention therefore there is provided a device for theexamination of, and the application of suction to, the bowel comprisingin combination a tube or pipe for connection at one end to a source ofsuction pressure and having a container for fluid which in operation isdrawn off by the device, the other end of said tube being ofsubstantially egg shape and at least partially of transparent material,said other end having apertures therethrough for the trans-mission,during use, of suction pressure, and a rectoscope the optical system ofwhich is disposed in said egg shaped end. By means of this transparentegg shaped member and the built-in optical system, the examination ofthe rectum, and particularly of the mucosa is made possible, by means-ofthe boreholes provided in the egg shaped member an'd the suctionpressure produced there the blocked pores of the uppermost layer ofmucosa are cleared and the fluid secretions beneath sucked off. At thesame time these steps are rendered visible by the built-in opticalsystem, and thus the position and extent of the invisible fluidsecretions can be recognised. The incorporation of the optical systemmakes it furthermore possible that the suction action at a diseased areashall not last longer than is really necessary, and that the suctionaction in the healthy area of the bowel shall be limited to a shorttime. Since the bowel is constricted in the diseased area and the poresof the tunica are blocked up, the apparatus, before the actual treatmentmust stretch the bowel in order to loosen the fluid and excretaagglomerations which are blocking the pores, and to make the fluidsecretions lying beneath the tunica accessible to the influence of thesuction.

The accompanying drawing shows in cross section a combined suction andexamining apparatus for the rectum at the entry into the diseased end ofthe bowel. It consists in the main of a transparent egg shaped portion gto be introduced into the rectum by means of a composite suction tube orpipe 1. The tube 1 is reduced at the other end to a mouthpiece h whichreceives a tube (not shown) leading to the suction pump. On itsunderside the suction tube is provided with an aperture i through whichthe fluid sucked off can emerge into a container k, connected therewithin an airtight manner, this container being preferably of transparentmaterial. The egg portion g at the outermost end of the suction pipe hason its circumference bore holes I or other apertures which transmit thesuction pressure produced inside the egg portion to the pores of thetunica mucosa,

stretched by the said egg portion, and to the bowel wall therebeneath.The start and the finish of the suction action, as well as the surfaceto the mucosa are observed through the optical system, incorporated inthe suction tube or the egg portion by means of a lamp and mirror m inthe rectoscope r, and the eye-piece n at the end of the suction tube. Agraduated linear scale is provided on the suction tube in order tofacilitate reading the distance between the fluid secretion and theanus.

The length scale 0 also enables the reading of the length to which theinstrument has been inrtoduced into the intestine so that a repeatedtreatment of one and the same part of the intestine is possible withoutneed for using the optical system of the rectoscope because the scale 0enables the movement of the egg-shaped hollow body g to be moved alwaysto the same point of the intestine by reference to one and the samedivision of the scale 0.

What is claimed is:

1. A surgical apparatus for examination of diseased mucosa in anintestine and for withdrawal by suction of secretion from the mucosa,particularly in the area of the sigmoid fiexure of the intestine, saidapparatus comprising, in combination, an elongated suction tube ofsubstantially constant diameter, said suction tube having a first and asecond longitudinal end and formed with a smooth outer surface; asubstantially egg-shaped hollow body airtightly joined with onelongitudinal end of said suction tube, said hollow body having a smoothouter surface with a gradual transition into the outer surface of saidsuction tube and formed with aperture means communicating with theinterior of said suction tube; a rectoscope disposed in said suctiontube, said rectoscope comprising an optical system for observation ofthe mucosa normally located in said hollow body and eyepiece meansoptically coaxial with and spaced from said optical system and locatedat the other longitudinal end of said suction tube; container meanscommunicatively connected with said suction tube in the proximity ofsaid other end thereof; and means provided in the proximity of saidother end for connecting said suction tube to a souce of vacuum whereby,when said hollow body is inserted into the intestine, secretion iswithdrawn from the mucosa through said aperture means and through saidsuction tube and is collected in said container means.

2. A surgical apparatus for examination of diseased mucosa in anintestine and for withdrawal by suction of secretion from the mucosa,particularly in the area of the sigmoid fiexure of the intestine, saidapparatus comprising, in combination, an elongated suction tube ofsubstantially constant diameter, said suction tube having a first and asecond longitudinal end and formed with a smooth outer surface; asubstantially egg-shaped hollow body of transparent material airtightlyjoined with one longitudinal end of said suction tube, said hollow bodyhaving a smooth outer surface with a gradual transition into the outersurface of said suction tube and formed with aperture meanscommunicating with the interior of said suction tube; a rectoscopedisposed in said suction tube, said rectoscope comprising an opticalsystem for observation of the mucosa normally located in said hollowbody and eyepiece means optically coaxial with and spaced from saidoptical system and located at the other longitudinal end of said suctiontube; container means communicatively connected with said suction tubein the proximity of said other end thereof; and means provided in theproximity of said other end for connecting said suction tube to a sourceof vacuum whereby, when said hollow body is inserted into the intestine,secretion is withdrawn from the mucosa through said aperture means andthrough said suction tube and is collected in said container means.

3. A surgical apparatus for examination of diseased mucosa in anintestine and for withdrawal by suction of secretion from the mucosa,particularly in the area of the sigmoid flexure of the intestine, saidapparatus comprising, in combination, an elongated suction tube ofsubstantially constant diameter, said suction tube having a first and asecond longitudinal end and formed with a smooth outer surface; asubstantially egg-shaped hollow body airtightly joined with onelongitudinal end of said suction tube, said hollow body having a smoothouter surface with a gradual transition into the outer surface of saidsuction tube and formed with aperture means communicating with theinterior of said suction tube, at least a portion of said suction tubeadjacent to said hollow body consisting of transparent material; arectoscope disposed in said suction tube,.said rectoscope comprising anoptical system for observation of the mucosa normally located in saidhollow body and eyepiece means optically coaxial with and spaced fromsaid optical system and located at the other longitudinal end of saidsuction tube; container means communicatively connected with siadsuction tube in the proximity of said other end thereof; and meansprovided in the proximity of said other end for connecting said suctiontube to a source of vacuum whereby,.when said hollow body is inserted inthe intestine, secretion is withdrawn from'the mucosa through saidaperture means and through said suction tube and is collected in saidcontainer means.

References Cited in the file of this patent UNITED STATES PATENTS1,643,631 Schulz Sept. 27, 1927 2,555,493 Kirschbaum June 5, 19512,704,541 Wyatt Mar. 22 1955

